Overview of novel

coronavirus
(2019-nCoV)
The right clinical information, right where it's needed

Last updated: Feb 06, 2020

 Table of Contents
Introduction 3

Conditions 8

Online resources 10

References 12

Disclaimer 14
Overview of novel coronavirus (2019-nCoV) Introduction

Introduction
Novel coronavirus (2019-nCoV) was first identified during an outbreak of pneumonia in Wuhan City, Hubei

INTRODUCTION
Province, China in December 2019. The World Health Organization (WHO) recommend that the interim
name of the disease causing the current outbreak should be 2019-nCoV acute respiratory disease, and
that the interim name of the virus should be 2019-nCoV; however, the final names are yet to be decided.
Investigations to learn more about the virus, its origin, and how it affects humans are ongoing, and the
situation is evolving rapidly.

This topic was last updated on the 6th February 2020.

What's new
• China has reported 3694 new confirmed cases (2987 in Hubei Province), including 640 severe cases,
and 73 new deaths on the 5th February.[1]

• Belgium has reported its first case. There are now at least 191 confirmed cases reported outside of
China across 24 countries.[2]

• WHO have declared the outbreak to be a public health emergency of international concern.[3] They
currently assess the risk to be very high in China, high at the regional level, and high at the global
level.

Epidemiology
• On the 31st December, 2019, WHO was informed of 44 cases of pneumonia of unknown microbial
aetiology associated with Wuhan City, Hubei Province, China. Most of the patients in the outbreak
reported a link to a large seafood and live animal market (Huanan South China Seafood Market),
which has been closed since the 1st January, 2020 for environmental sanitation and disinfection.[4]

• On the 9th January 2020, WHO announced that a novel coronavirus that has not previously been
identified in humans had been detected in samples taken from patients in Wuhan City. Laboratory
tests ruled out SARS-CoV, MERS-CoV, influenza, avian influenza, and other common respiratory
pathogens.[5]

• As of the 5th February, China's National Health Commission have reported 28,018 confirmed cases
(with 3859 severe cases) and 24,702 suspected cases across China. The majority of cases are
in Hubei Province. An additional 42 cases have been reported in Hong Kong, Macau, and Taiwan
(special administrative regions of China). At least 563 deaths have been reported.[1]The number of
cases and deaths has now surpassed the number of cases and deaths in mainlaind China during the
2002-2003 SARS outbreak.
• As of the 5th February, at least 191 cases have been confirmed in 24 countries outside of China in
the following countries: Australia, Belgium, Cambodia, Canada, Finland, France, Germany, India, Italy,
Japan, Malaysia, Nepal, The Philippines, Russia, Singapore, South Korea, Spain, Sri Lanka, Sweden,
Thailand, United Arab Emirates, United Kingdom, United States, and Vietnam. Two deaths have now
been reported outside of mainland China, one in the Philippines and one in Hong Kong.[2]

• [WHO: novel coronavirus (2019-nCoV) situation reports]

• [CDC: global map - locations with confirmed 2019-nCoV cases]

Etiology
• 2019-nCoV is a betacoronavirus. Coronaviruses are a large family of viruses, some of which cause
illness in people (e.g., common cold, severe acute respiratory syndrome [SARS], Middle East
respiratory syndrome [MERS]), and others that circulate among mammals and birds. Rarely, animal

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 Overview of novel coronavirus (2019-nCoV) Introduction
coronaviruses can spread to humans, and then spread between people as was the case with MERS
and SARS.
INTRODUCTION

• A majority of patients in the initial outbreak in Wuhan City reported a link to Huanan South China
Seafood Market, which suggests a zoonotic origin of the virus. However, the origin of the virus is
yet to be confirmed. An animal reservoir is unknown at this point. The virus has been found to be
similar to SARS-like coronaviruses from bats, but it is distinct from SARS-CoV and MERS-CoV. One
study suggests that the virus may be a recombinant virus between the bat coronavirus and an origin-
unknown coronavirus, possibly from snakes;[6] however, there is no evidence to support this.

• Person-to-person spread has been confirmed in community and health care settings in China,
as well as Vietnam, Japan, Thailand, Germany, and the US.[7] [8] [9] [3] An initial assessment of
the transmission dynamics in the first 425 confirmed cases found that 55% of cases before 1st
January 2020 were linked to Huanan South China Seafood Market; whereas, only 8.6% of cases
after this date were linked to the market. This confirms that person-to-person spread has occurred
among close contacts since the middle of December 2019. Infections in health care workers have
been confirmed.[10] It is uncertain how easily the virus spreads between people. It is possible that
asymptomatic carriers may be able to infect people as there is a confirmed report of transmission from
an asymptomatic contact in Germany.[11]

• The full genome of the virus has been published in GenBank. [GenBank]

Diagnosis
• Early recognition and rapid diagnosis are essential to prevent transmission and to provide supportive
care in a timely manner. Triage all patients on admission, and immediately isolate all suspected and
confirmed cases in area separate from other patients. Implement appropriate infection prevention
and control measures. Screening questionnaires may be helpful, and travel history is key. Report all
suspected and confirmed cases to your local health authorities.

• Diagnosis should be suspected in patients with fever and/or symptoms of lower respiratory illness
(e.g., cough, dyspnoea) who reside in, or have travelled to China (particularly Hubei Province), or any
other affected areas within the last 14 days. Diagnosis should also be suspected in patients with fever
and/or symptoms of lower respiratory illness (e.g., cough, dyspnoea) who report close contact with a
suspected or confirmed case of 2019-nCoV within the last 14 days.[12] [13]

• Current estimates of the incubation period range from 2 to 10 days,[14] with an estimated median of
5.2 days.[10]
• Males are more commonly affected, and the median age range of patients is 49 to 59 years.[10] [15]
[16]

• The clinical presentation greatly resembles viral pneumonia, and severity ranges from mild to severe.
The majority of patients present with mild illness. Approximately 20% of cases progress to severe
disease.[17] Severe illness may be more likely in older people or those with underlying health
conditions.

• The most common symptoms are fever, cough, and dyspnoea. Other less common symptoms include
myalgia, fatigue, sputum production, confusion, headache, sore throat, rhinorrhoea, chest pain,
haemoptysis, diarrhoea, and nausea/vomiting. Approximately 90% of patients present with more than
one symptom, and 15% of patients present with fever, cough, and dyspnoea. Clinical presentations
resemble SARS, but it appears that fewer patients have upper respiratory or gastrointestinal
symptoms.[16] [15] Some patients may be asymptomatic.

• Approximately 33% of patients have complications such as acute respiratory distress syndrome, acute
respiratory injury, septic shock, and acute renal injury. Acute cardiac injury and secondary infections
have also been reported.[16] [15]

• Unilateral lung infiltrates are found in 25% of patients, with bilateral lung infiltrates found in 75% of
patients on chest x-ray or computed tomography (CT).[16] [15]

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Overview of novel coronavirus (2019-nCoV) Introduction

• Molecular testing with real-time reverse-transcriptase polymerase chain reaction (RT-PCR) is required
to confirm the diagnosis.

INTRODUCTION
• Detailed guidance on the diagnosis of 2019-nCoV is available from WHO:

• [WHO: surveillance case definitions for human infection with novel coronavirus (nCoV)]

• [WHO: laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases]

Management
• No specific treatments are available for the treatment of 2019-nCoV; therefore, the mainstay of
management is optimised supportive care to relieve symptoms and to support organ function in more
severe illness. There are no specific antivirals available; however, some existing antivirals are being
used as part of clinical trials.

• Management involves the following principles:

• Isolation of suspected and confirmed cases, and appropriate infection prevention and control
measures (standard, droplet, airborne, and contact precautions)

• Managing sepsis (if suspected)

• Supportive therapies (e.g., oxygen, fluid management, analgesics/antipyretics, empirical

antimicrobials, intubation, mechanical ventilation)

• Close monitoring for signs of deterioration.

• Patients with impending or established respiratory failure should be admitted to the intensive care unit.
All cases should be isolated and monitored in a hospital setting where possible; however, home care
may be suitable for some patients with mild illness. This should be decided on a case-by-case basis.

• Detailed guidance on the management of 2019-nCoV is available from WHO:

• [WHO: clinical management of severe acute respiratory infection when novel coronavirus
(nCoV) infection is suspected]

• [WHO: home care for patients with suspected novel coronavirus (nCoV) infection presenting
with mild symptoms and management of contacts]

Prevention
• China's National Health Commission have classified novel coronavirus as a grade A infectious disease
which requires the strictest prevention and control measures, including mandatory quarantine of
patients and observation for those who have had close contact with patients.[18] Numerous cities in
China are now on lockdown with travel bans and public transport services suspended.

• The US Centers for Disease Control and Prevention (CDC) recommend that travellers should avoid
all non-essential travel to China (level 3 alert). Chinese officials have closed transport into and out of
Wuhan City and other areas in Hubei Province including buses, subways, trains, and airports. Other
locations may be affected. [CDC: travelers' health - novel coronavirus in China] The US government
has declared a public health emergency, and has recommended avoiding all travel to China. It is also
temporarily restricting entry to foreign nationals who have recently visited China in the past 14 days.
Other countries are following suit; check local guidance. 

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 Overview of novel coronavirus (2019-nCoV) Introduction

• Despite guidance from other agencies, WHO does not currently recommend any travel or trade
restrictions. They advise international travellers to practice usual precautions while travelling in or from
affected areas, including: avoiding close contact with people suffering acute respiratory infections;
INTRODUCTION

frequent hand washing, especially after contact with people who are ill or their environment; practicing
appropriate cough etiquette; avoiding consumption of raw or undercooked animal products; and
avoiding close contact with live or dead farm or wild animals. [WHO: novel coronavirus (2019-nCoV)
travel advice]

• A number of countries are actively screening incoming travellers from Hubei Province at airports for
signs and symptoms of infection. Some airlines are suspending flights to and from China.

• There is currently no vaccine available; however, they are in development.

• Detailed guidance on infection prevention and control is available from WHO:

• [WHO: infection prevention and control during health care when novel coronavirus (nCoV)
infection is suspected]

Prognosis
• The overall case fatality rate appears to be approximately 2% to 3% based on initial case reports;
however, this estimate should be treated with caution as the true number of infections and disease
course are still unknown at this time. Most of those who died were older and/or had underlying health
conditions. Case fatality rates were approximately 37% for MERS and 10% for SARS.[19]

Other guidelines
• [CDC: interim guidance for healthcare professionals]

• [CDC: interim clinical guidance for management of patients with confirmed 2019 novel coronavirus
(2019-nCoV) infection]

• [CDC: interim health care infection prevention and control recommendations for patients under
investigation for 2019 novel coronavirus]

• [CDC: interim guidance for implementing home care of people not requiring hospitalization for 2019
novel coronavirus (2019-nCoV)]

• [CDC: interim US guidance for risk assessment and public health management of persons with
potential 2019 novel coronavirus (2019-nCoV) exposure in travel-associated or community settings]

• [CDC: information for laboratories]

• [Public Health England: novel coronavirus (2019-nCoV)]

• [Public Health England: coronavirus - latest information and advice]

• [WHO: novel coronavirus (2019-nCoV) technical guidance]

• [WHO: advice on the use of masks the community, during home care and in health care settings in the
context of the novel coronavirus (2019-nCoV) outbreak]

• [Chinese Center for Disease Control and Prevention: pneumonitis infected by novel coronavirus]

• [Department of Health Australia: novel coronavirus 2019 (2019-nCoV)]

• [European Centre for Disease Prevention and Control: novel coronavirus]

• [Government of Canada: 2019 novel coronavirus]

• [Ministry of Health Singapore: updates on 2019 novel coronavirus (2019-nCoV) local situation]

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Overview of novel coronavirus (2019-nCoV) Introduction

Resources
• [BMJ: coronavirus]

INTRODUCTION
• [WHO: novel coronavirus (2019-nCoV)]

• [WHO: novel coronavirus (2019-nCoV) advice for the public]

• [CDC: 2019 novel coronavirus, Wuhan, China]

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 Overview of novel coronavirus (2019-nCoV) Conditions

Conditions

◊ Middle East respiratory syndrome (MERS)

» see our comprehensive coverage of Middle East respiratory syndrome (MERS)
An acute viral respiratory tract infection caused by the novel betacoronavirus MERS-CoV, first identified
in Saudi Arabia in 2012. Cases have been limited to the Arabian Peninsula and its surrounding countries,
and to travellers from the Middle East or their contacts.

◊ Severe acute respiratory syndrome (SARS)

» see our comprehensive coverage of Severe acute respiratory syndrome (SARS)
A viral pneumonia that rapidly progresses to respiratory failure caused by the novel SARS-CoV
coronavirus. There have been no reported cases since 2004.
CONDITIONS

◊ Avian influenza A (H5N1) virus infection

» see our comprehensive coverage of Avian influenza A (H5N1) virus infection
Highly pathogenic avian influenza (HPAI) A H5N1 virus originates in poultry and wild birds can be
transmitted to humans, with rare cases of infection transmitted between humans.

◊ Avian influenza A (H7N9) virus infection

» see our comprehensive coverage of Avian influenza A (H7N9) virus infection
Geographically focused in China and associated with exposure to infected poultry. Five annual
epidemic waves of human cases occurred from 2013 to 2017. Case clusters of limited human-to-human
transmission have been described, but there is no evidence of sustained transmission.

◊ Influenza infection
» see our comprehensive coverage of Influenza infection
Acute respiratory tract infection typically caused by seasonal influenza A or B virus. The virus is
transmitted by inhalation of infected respiratory secretions that have been aerosolised through coughing,
sneezing, or talking.

◊ Community-acquired pneumonia
» see our comprehensive coverage of Community-acquired pneumonia
Pneumonia acquired outside hospital or healthcare facilities. Clinical diagnosis is based on a group
of signs and symptoms related to lower respiratory tract infection with presence of fever, cough,
expectoration, chest pain, dyspnoea, and signs of invasion of the alveolar space.

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Overview of novel coronavirus (2019-nCoV) Conditions

◊ Atypical pneumonia
» see our comprehensive coverage of Atypical pneumonia
Atypical bacterial pneumonia is caused by atypical organisms that are not detectable on Gram stain and
cannot be cultured using standard methods.

◊ Acute respiratory distress syndrome

» see our comprehensive coverage of Acute respiratory distress syndrome
Non-cardiogenic pulmonary oedema and diffuse lung inflammation syndrome that often complicates
critical illness. Possible complication of novel coronavirus infection.

◊ Sepsis
» see our comprehensive coverage of Sepsis
Life-threatening organ dysfunction caused by a dysregulated host response to an infection. Possible

CONDITIONS
complication of novel coronavirus infection.

◊ Shock
» see our comprehensive coverage of Shock
Life-threatening failure of adequate oxygen delivery to the tissues and may be due to decreased blood
perfusion of tissues, inadequate blood oxygen saturation, or increased oxygen demand from the tissues
that results in decreased end-organ oxygenation and dysfunction. Possible complication of novel
coronavirus infection.

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 Overview of novel coronavirus (2019-nCoV) Online resources

Online resources
1. WHO: novel coronavirus (2019-nCoV) situation reports (external link)

2. CDC: global map - locations with confirmed 2019-nCoV cases (external link)

3. GenBank (external link)

4. WHO: surveillance case definitions for human infection with novel coronavirus (nCoV) (external link)

5. WHO: laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases (external
link)

6. WHO: clinical management of severe acute respiratory infection when novel coronavirus (nCoV)
infection is suspected (external link)

7. WHO: home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild
symptoms and management of contacts (external link)

8. CDC: travelers' health - novel coronavirus in China (external link)

9. WHO: novel coronavirus (2019-nCoV) travel advice (external link)

10. WHO: infection prevention and control during health care when novel coronavirus (nCoV) infection is
suspected (external link)

11. CDC: interim guidance for healthcare professionals (external link)

ONLINE RESOURCES

12. CDC: interim clinical guidance for management of patients with confirmed 2019 novel coronavirus
(2019-nCoV) infection (external link)

13. CDC: interim health care infection prevention and control recommendations for patients under
investigation for 2019 novel coronavirus (external link)

14. CDC: interim guidance for implementing home care of people not requiring hospitalization for 2019
novel coronavirus (2019-nCoV) (external link)

15. CDC: interim US guidance for risk assessment and public health management of persons with
potential 2019 novel coronavirus (2019-nCoV) exposure in travel-associated or community settings
(external link)

16. CDC: information for laboratories (external link)

17. Public Health England: novel coronavirus (2019-nCoV) (external link)

18. Public Health England: coronavirus - latest information and advice (external link)

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Overview of novel coronavirus (2019-nCoV) Online resources
19. WHO: novel coronavirus (2019-nCoV) technical guidance (external link)

20. WHO: advice on the use of masks the community, during home care and in health care settings in the
context of the novel coronavirus (2019-nCoV) outbreak (external link)

21. Chinese Center for Disease Control and Prevention: pneumonitis infected by novel coronavirus
(external link)

22. Department of Health Australia: novel coronavirus 2019 (2019-nCoV) (external link)

23. European Centre for Disease Prevention and Control: novel coronavirus (external link)

24. Government of Canada: 2019 novel coronavirus (external link)

25. Ministry of Health Singapore: updates on 2019 novel coronavirus (2019-nCoV) local situation (external
link)

26. BMJ: coronavirus (external link)

27. WHO: novel coronavirus (2019-nCoV) (external link)

28. WHO: novel coronavirus (2019-nCoV) advice for the public (external link)

29. CDC: 2019 novel coronavirus, Wuhan, China (external link)

ONLINE RESOURCES

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 Overview of novel coronavirus (2019-nCoV) References

Key articles
References
REFERENCES

1. National Health Commission of the People's Republic of China. Update on pneumonia of new
coronavirus infection as of 24:00 on February 5. Feb 2020 [internet publication]. Full text

2. World Health Organization. Novel coronavirus (2019-nCoV). Situation report -16. 05 Feb 2020 [internet
publication]. Full text

3. World Health Organization. Statement on the second meeting of the International Health Regulations
(2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). 30 Jan 2020
[internet publication]. Full text

4. World Health Organization. Pneumonia of unknown cause – China. Disease outbreak news. Jan 2020
[internet publication]. Full text

5. World Health Organization. Novel coronavirus - China. Disease outbreak news: update. Jan 2020
[internet publication]. Full text

6. Ji W, Wang W, Zhao X, et al. Homologous recombination within the spike glycoprotein of the newly
identified coronavirus may boost cross-species transmission from snake to human. J Med Virol. 2020
Jan 22. Abstract

7. National Health Commission of the People's Republic of China. Top expert: disease spread won't be
on scale of SARS. Jan 2020 [internet publication]. Full text

8. Phan LT, Nguyen TV, Luong QC, et al. Importation and human-to-human transmission of a novel
coronavirus in Vietnam. N Engl J Med. 2020 Jan 28 [Epub ahead of print]. Full text

9. Centers for Disease Control and Prevention. CDC confirms person-to-person spread of new
coronavirus in the United States. 30 Jan 2020 [internet publication]. Full text

10. Li, Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–
infected pneumonia. N Engl J Med. 2020 Jan 29 [Epub ahead of print]. Full text

11. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic
contact in Germany. N Engl J Med. 2020 Jan 30 [Epub ahead of print]. Full text

12. World Health Organization. Surveillance case definitions for human infection with novel coronavirus
(nCoV). Jan 2020 [internet publication]. Full text

13. Centers for Disease Control and Prevention. 2019 novel coronavirus. Interim guidance for healthcare
professionals. Jan 2020 [internet publication]. Full text

14. World Health Organization. Novel coronavirus (2019-nCoV) situation report - 6. 26 Jan 2020 [internet
publication]. Full text

12 This PDF of the BMJ Best Practice topic is based on the web version that was last updated: Feb 06, 2020.
BMJ Best Practice topics are regularly updated and the most recent version
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Overview of novel coronavirus (2019-nCoV) References
15. Chen N, Zhou, Dong, X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel
coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Jan 29 [Epub ahead of
print]. Full text

REFERENCES
16. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in
Wuhan, China. Lancet. 2020 Jan 24. pii: S0140-6736(20)30183-5 [Epub ahread of print]. Full text

17. World Health Organization. Novel coronavirus (2019-nCoV). Situation report -8. 28 Jan 2020 [internet
publication]. Full text

18. National Health Commission of the People's Republic of China. Strictest measures enacted to contain
viral pneumonia. Jan 2020 [internet publication]. Full text

19. Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern. Lancet.
2020 Jan 24. pii: S0140-6736(20)30185-9 [Epub ahead of print]. Full text

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 Overview of novel coronavirus (2019-nCoV) Disclaimer

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Contributors:

// Authors:

Editorial Team,
BMJ Publishing Group
DISCLOSURES: This overview topic has been peer reviewed by Ioannis P. Kioumis, MD, PhD (Associate
Professor in Pulmonary Medicine, Infectious Diseases, Thessaloniki, Greece); Chad J. Achenbach, MD,
MPH (Assistant Professor of Medicine, Infectious Diseases, Chicago, IL); and Catia Cilloniz, MSc, PhD
(Post-doctoral Research, Pneumology Department, Barcelona, Spain).